Overview of rectal prolapse in children
- Rana Kronfol, MD
Rana Kronfol, MD
- Assistant Professor of Pediatric Emergency Medicine
- Baylor College of Medicine
- Section Editors
- Craig Jensen, MD
Craig Jensen, MD
- Section Editor — Pediatric Gastroenterology
- Associate Professor
- Baylor College of Medicine
- Jonathan I Singer, MD
Jonathan I Singer, MD
- Section Editor — Pediatric Surgical Emergencies
- Professor of Emergency Medicine and Pediatrics
- Wright State University Boonshoft School of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Rectal prolapse refers to the extrusion of some or all of the rectal mucosa through the external anal sphincter (figure 1) [1-4]. Rectal prolapse seldom occurs in children who do not have an underlying predisposing condition and usually occurs between infancy and four years of age, with the highest incidence in the first year of life [1,5]. During childhood, rectal prolapse occurs with equal frequency in boys and girls [1,6,7].
There are two types of rectal prolapse . Type I, also called false procidentia, partial, or mucosal prolapse, involves protrusion of the mucosa only and usually is less than 2 cm long. Partial rectal prolapse produces radial folds at the junction with the anal skin (figure 1).
Type II, also known as true procidentia, or complete prolapse, involves full thickness extrusion of the rectal wall and is characterized by concentric folds in the prolapsed mucosa (picture 1). This group is subdivided into three subsets according to the degree of the prolapse:
●First degree prolapse includes the mucocutaneous junction. The length of the protrusion from the anal verge usually is greater than 5 cm.
●Second degree prolapse occurs without involvement of the mucocutaneous junction. The length of the protrusion from the anal verge usually is between 2 and 5 cm.
- Corman ML. Rectal prolapse in children. Dis Colon Rectum 1985; 28:535.
- Henry MM. Rectal prolapse. Br J Hosp Med 1980; 24:302, 305, 307.
- Henry LG, Cattey RP. Rectal prolapse. Surg Laparosc Endosc 1994; 4:357.
- Siafakas C, Vottler TP, Andersen JM. Rectal prolapse in pediatrics. Clin Pediatr (Phila) 1999; 38:63.
- Chan WK, Kay SM, Laberge JM, et al. Injection sclerotherapy in the treatment of rectal prolapse in infants and children. J Pediatr Surg 1998; 33:255.
- Narasanagi SS. Rectal prolapse in children. J Indian Med Assoc 1974; 62:378.
- Dutta BN, Das AK. Treatment of prolapse rectum in children with injections of sclerosing agents. J Indian Med Assoc 1977; 69:275.
- Duhamel J, Pernin P. [Anal prolapse in the child]. Ann Gastroenterol Hepatol (Paris) 1985; 21:361.
- RIPSTEIN CB, LANTER B. Etiology and surgical therapy of massive prolapse of the rectum. Ann Surg 1963; 157:259.
- Freeman NV. Rectal prolapse in children. J R Soc Med 1984; 77 Suppl 3:9.
- Magnus, RV. The folds of Houston in infancy. J Pediatr Surg 1967; 2:431.
- Severijnen R, Festen C, van der Staak F, Rieu P. Rectal prolapse in children. Neth J Surg 1989; 41:149.
- Suzuki H, Amano S, Matsumoto K, Tsukamoto Y. Anorectal motility in children with complete rectal prolapse. Prog Pediatr Surg 1989; 24:105.
- Pena A. Rectal prolapse. In: Nelson's Essentials of Pediatrics, Behman RE, Kliegman R, Nelson WE. (Eds), WB Saunders, St. Louis 2002. p.1182.
- Zempsky WT, Rosenstein BJ. The cause of rectal prolapse in children. Am J Dis Child 1988; 142:338.
- Harris, PR, Figueroa-Colon, R. Rectal prolapse in children associated with Clostridium difficile infection. Pediatri Infect Dis J 1995;14:78.
- Jacobs LK, Lin YJ, Orkin BA. The best operation for rectal prolapse. Surg Clin North Am 1997; 77:49.
- Malik M, Stratton J, Sweeney WB. Rectal prolapse associated with bulimia nervosa: report of seven cases. Dis Colon Rectum 1997; 40:1382.
- Eriksen CA, Hadley GP. Rectal prolapse in childhood--the role of infections and infestations. S Afr Med J 1985; 68:790.
- Huskins WC, Griffiths JK, Faruque AS, Bennish ML. Shigellosis in neonates and young infants. J Pediatr 1994; 125:14.
- Harris PR, Figueroa-Colon R. Rectal prolapse in children associated with Clostridium difficile infection. Pediatr Infect Dis J 1995; 14:78.
- Stephenson LS, Holland CV, Cooper ES. The public health significance of Trichuris trichiura. Parasitology 2000; 121 Suppl:S73.
- Grodinsky S, Telmesani A, Robson WL, et al. Gastrointestinal manifestations of hemolytic uremic syndrome: recognition of pancreatitis. J Pediatr Gastroenterol Nutr 1990; 11:518.
- Bhimma R, Rollins NC, Coovadia HM, Adhikari M. Post-dysenteric hemolytic uremic syndrome in children during an epidemic of Shigella dysentery in Kwazulu/Natal. Pediatr Nephrol 1997; 11:560.
- Cameron AE, Wyatt AP. Asthma, rectal prolapse and malabsorption. J R Soc Med 1978; 71:529.
- KULCZYCKI LL, SHWACHMAN H. Studies in cystic fibrosis of the pancreas; occurrence of rectal prolapse. N Engl J Med 1958; 259:409.
- Mazumder RN, Ashraf H, Hoque SS, et al. Effect of an energy-dense diet on the clinical course of acute shigellosis in undernourished children. Br J Nutr 2000; 84:775.
- Patwardhan N, Kiely EM, Drake DP, et al. Colostomy for anorectal anomalies: high incidence of complications. J Pediatr Surg 2001; 36:795.
- Nagle D. Rectal prolapse and fecal incontinence. Prim Care 1999; 26:101.
- Cheetham MJ, Malouf AJ, Kamm MA. Fecal incontinence. Gastroenterol Clin North Am 2001; 30:115.
- Rittmeyer C, Nakayama D, Ulshen MH. Lymphoid hyperplasia causing recurrent rectal prolapse. J Pediatr 1997; 131:487.
- Douglas BS, Douglas HM. Rectal prolapse in the Ehlers-Danlos syndrome. Aust Paediatr J 1973; 9:109.
- Committee on Genetics. American Academy of Pediatrics: Health care supervision for children with Williams syndrome. Pediatrics 2001; 107:1192.
- Clancy RL, Mackay IR. Myxoedematous ascites. Med J Aust 1970; 2:415.
- Sohn N, Weinstein MA, Robbins RD. Anorectal disorders. Curr Probl Surg 1983; 20:1.
- Traisman E, Conlon D, Sherman JO, Hageman JR. Rectal prolapse in two neonates with Hirschsprung's disease. Am J Dis Child 1983; 137:1126.
- Pace S, Young G. Rectal prolapse. In: Clinical Procedures in Emergency Medicine, 3rd, Roberts JR, Hedges JR. (Eds), WB Saunders, Philadelphia 1998. p.769.
- Alghanem AA, McCauley RL, Robson MC, et al. Management of pediatric perineal and genital burns: twenty-year review. J Burn Care Rehabil 1990; 11:308.
- Loredo-Abdalá A, Trejo-Hernández J, Monroy-Villafuerte A, et al. Rectal prolapse in pediatrics. Clin Pediatr (Phila) 2000; 39:131.
- White CM, Findlay JM, Price JJ. The occult rectal prolapse syndrome. Br J Surg 1980; 67:528.
- Alexander-Williams J. Solitary-ulcer syndrome of the rectum. Its association with occult rectal prolapse. Lancet 1977; 1:170.
- Chaloner EJ, Duckett J, Lewin J. Paediatric rectal prolapse in Rwanda. J R Soc Med 1996; 89:688.
- Schwartz G. Reducing a rectal prolapse. In: Textbook of Pediatric Emergency Procedures, Henretig FM, King C. (Eds), Williams & Wilkins, Baltimore 1996. p.947.
- Mönig SP, Selzner M, Schmitz-Rixen T. Peutz-Jeghers syndrome in a child. Prolapse of a large colonic polyp through the anus. J Clin Gastroenterol 1997; 25:703.
- Coburn WM 3rd, Russell MA, Hofstetter WL. Sucrose as an aid to manual reduction of incarcerated rectal prolapse. Ann Emerg Med 1997; 30:347.
- Azimuddin K, Khubchandani IT, Rosen L, et al. Rectal prolapse: a search for the "best" operation. Am Surg 2001; 67:622.
- Corman ML. Rectal prolapse. Surgical techniques. Surg Clin North Am 1988; 68:1255.
- Nelson H, Dozois R. Prolapse of the rectum. In: Sabiston Review of Surgery, 3rd, Townsend CM, Sabiston DC. (Eds), WB Saunders, Philadelphia 2001. p.978.
- Pikarsky AJ, Joo JS, Wexner SD, et al. Recurrent rectal prolapse: what is the next good option? Dis Colon Rectum 2000; 43:1273.
- Laituri CA, Garey CL, Fraser JD, et al. 15-Year experience in the treatment of rectal prolapse in children. J Pediatr Surg 2010; 45:1607.
- Wyllie GG. The injection treatment of rectal prolapse. J Pediatr Surg 1979; 14:62.
- Kay NR, Zachary RB. The treatment of rectal prolapse in children with injections of 30 per cent saline solutions. J Pediatr Surg 1970; 5:334.
- Malyshev YI, Gulin VA. Our experience with the treatment of rectal prolapse in infants and children. Am J Proctol 1973; 24:470.
- Groff DB, Nagaraj HS. Rectal prolapse in infants and children. Am J Surg 1990; 160:531.
- Schepens MA, Verhelst AA. Reappraisal of Ekehorn's rectopexy in the management of rectal prolapse in children. J Pediatr Surg 1993; 28:1494.
- Godbole P, Botterill I, Newell SJ, et al. Solitary rectal ulcer syndrome in children. J R Coll Surg Edinb 2000; 45:411.
- Felt-Bersma RJ, Cuesta MA. Rectal prolapse, rectal intussusception, rectocele, and solitary rectal ulcer syndrome. Gastroenterol Clin North Am 2001; 30:199.
- Lopez EL, Devoto S, Fayad A, et al. Association between severity of gastrointestinal prodrome and long-term prognosis in classic hemolytic-uremic syndrome. J Pediatr 1992; 120:210.
- PREDISPOSING CONDITIONS
- Intraabdominal pressure
- Diarrheal disease
- Cystic fibrosis
- Pelvic floor weakness
- Other factors
- CLINICAL MANIFESTATIONS
- DIFFERENTIAL DIAGNOSIS
- Manual reduction
- Surgical reduction
- INFORMATION FOR PATIENTS